18B. Integrative Solutions for the Irritable Bowel Syndrome

The irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain and altered bowel movements. The diagnosis of IBS is established by the Rome III criteria. IBS afflicts 10% to 15% of the US population (30 million Americans) and is the most common digestive disorder seen in the primary care setting. Patients with IBS have an impaired quality of life and high rate of absenteeism from work with diminished productivity. The utilization of healthcare resources by IBS patients costs an estimated 30 billion dollars annually. The pathophysiology of IBS involves a complex interplay of factors including hypothalamic-pituitary-adrenal axis dysregulation, heightened perceived stress, visceral hypersensitivity, inflammatory mediators, dietary triggers, gastrointestinal dysbiosis, and mast cell activation, among others. The conventional treatment of IBS is aimed at controlling symptoms with spasmolytic agents, antidepressants, laxatives, anti-diarrheal agents, and fiber supplements. Patients with IBS often are dissatisfied with the results of therapy and are looking for alternative treatment modalities to integrate into their care. Studies have demonstrated that approximately 50% of patients with IBS utilize at least one form of complementary and alternative medicine noting better control of symptoms. This session will review the evidence-based complementary and alternative medicine (CAM) modalities that have been proven efficacious for IBS. The program will be organized according to two areas of CAM; mind-body medicine aimed at stress reduction and reduced hyperalgesia and nutritional—including diet, herbal, and nutraceutical supplements. Discussion of the pathophysiology of IBS relevant to each corresponding category of CAM will be reviewed. Mind-body modalities to be presented will include hypnosis, gut-directed hypnosis, cognitive behavioral therapy, psychotherapy, biofeedback, meditation, and acupuncture. Nutritional modalities will include special diets (low FODMAP, lactose-free, wheat-free, elimination diets), herbals (Iberogast, curcumin, Chinese herbals, peppermint oil) and dietary supplements (melatonin, prebiotics, probiotics).